I would be very grateful for some advice on interpreting my results which came through today. Would you take any supplements with these results? My GP wants to review in 6months as my TSH keeps going up and down and would not test anything apart from TSH, T4 and T3 so I got a Blue Horizons thyroid plus eleven kit. I was really impressed with how fast the results came through. My GP does not want to start Levothyroxine yet, not until two consecutive tests show TSH above 5. Would be very grateful for any advice.
Hs-CRP 1.08 Range <5.0
Ferritin 72.5 Range 13-150
TSH 5.33 Range 0.27 - 4.20
Total T4 83.6 Range 66-181
Free T4 14.3 Range 12-22
Free T3 5.25 Range 3.1-6.8
Anti-thyroidperoxidase Abs 122 Range <34
Antithyroglobulin Abs 224 Range <115
VitD 62 Range insufficient30-50
VitB12 Range insufficient 145-300
Folate 22.2 Range 8.83-60.8
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rustysmum
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This isn't bad, recommended is half way through range. I'd just have an occasional meal of liver, black pudding, some liver pate, iron rich foods, to maintain your level.
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VitD 62 Range insufficient30-50
(24.8ng/ml)
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml). The Vit D Council recommends, to raise our current level to the recommended level, supplementing with 3,700iu D3 daily
When you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Because you have Hashi's then for best absorption consider an oral spray or sublingual drops for D3 and K2.
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Folate 22.2 Range 8.83-60.8
Not bad but a bit short of the recommended level, which is at least half way through range.
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VitB12 Range insufficien t 145-300
You haven't given a result for B12, just the range
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TSH 5.33 Range 0.27 - 4.20
Total T4 83.6 Range 66-181
Free T4 14.3 Range 12-22
Free T3 5.25 Range 3.1-6.8
Anti-thyroidperoxidase Abs 122 Range <34
Antithyroglobulin Abs 224 Range <115
TSH above range but below 10 is classed as Subclinical Hypothyroidism.
Your raised antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed. Fluctuations in symptoms and test results is common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
You can possibly help reduce the antibodies by adopting a strict gluten free diet which has helped many members here.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Normally, after two raised TSH results, when raised antibodies are present, an enlightened doctor would prescribe Levo. See article by Dr Toft (leading endocrinologist and past president of The British Thyroid Associatio) written for Pulse magazine (the magazine for doctors)
Question 2 asks:
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
Answer:
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.
Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 2 to show your doctor.
My GP does not want to start Levothyroxine yet, not until two consecutive tests show TSH above 5.
With Hashi's, because levels fluctuate with antibody activity, you may not get two consecutive results. If you've had two results over range that should be enough.
Thank you SeasideSusie. That is so very helpful. Sorry about the missing B12, it was 410.
So when I see my GP, apart from asking her to start the Levothyroxine earlier should I also be asking for an ultrasound or any other tests? Some people seem to get these automatically it seems?
Will be ordering some supplements as you have suggested.
Can I ask one other question please? If she agrees to start the Levothyroxine, do I need to keep this far apart from my HRT? I am using compounded creams so is this irrelevant in my case?
I really empathise with you. The first TSH test I got over 10yrs ago was 6.8 (0.3-5) I was on my knees with symptoms and trying to raise 4 children under 6yrs. I used to go to bed at 6pm and put the stair gate on and tell my nearly 6yr old to wait half an hour for Dad to come home from work. My then GP was so blasé about it that my now self is feels really angry towards him. I didn’t wait 6mths to go back for retesting, I waited 2mths and told him I wasnt leaving till someone helped me. That time I was tested and my result was 11.1 So over the magic number 10 😩
I am so sorry you are not getting treatment now. And I really hope you don’t wait 6mths. Keep going back, keep voicing your symptoms. Keep demanding monthly blood tests 🤗
You've had excellent advice about vitamins from Seaside Susie. It's such a travesty you're not being treated I definitely wouldn't call that 'normal freeT4', as it's very low in range. A healthy person would have a inner near the middle of the range.
I just wanted to express some support and outrage So many people are left in your position, and its so unfair.
It also makes me sad that if you follow Susie's advice andg improve your vitamin levels, it will likely improve your thyroid numbers a little. Which is good because you'll feel a bit better, but the catch-22 doctors put us in is the people who do everything right to improve their health get pushed even further down the queue to be treated
If they need to see 2 TSHs above 5 I would consider going to Medichecks every month to get their cheapest TSH test, and just wait until you get the figures they want to see Don't forget to take them as early as you can, and fasting.
In fact, if you get Medichecks and don't have to go into a venue to get blood taken, you could do it in the small hours of the morning, which I believe is that actual highest TSH we have. My memory is not so good, and you can find graphs showing the change throughout the day. It's certainly earlier than a phlebotomist would open that it goes the highest, and you might as well make use of that!
Thanks Silver Avocado. That is great advice. I know my GP is also reluctant as I am struggling with palpitations due to going through the menopause and she is concerned they will worsen on the medication. I would not be looking forward to that aspect of it. But have been struggling with my weight and awful tiredness for several years now. Had originally kept putting it down to ‘the change’ but no matter what diet I try my weight refuses to budge! Other menopausal friends can lose much more easily than me so I started to think that there must be something else going on.
Palpitations are most likely to lessen or stop completely when you correct your thyroid hormones. Only if you inadvertently ended up on too much hormone for a while are you in danger of getting racing heart or arrhythmia. Palpitations come from menopause hormone going up and down rapidly, and from hypothyroidism.
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I definitely wouldn't call that 'normal freeT4', as it's very low in range. A healthy person would have a inner near the middle of the range. 
Don't forget to take them as early as you can, and fasting. 
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